It’s been a controversial summer in nutrition news! One of the biggest stories was the New York Times article that reported that most of the Biggest Losers winners have regained all their weight and more.

Doomed to a Life of Overweight? The NYT Health section reported the news that all the Biggest Losers winners regained their weight. Then they did a deep dive on all the possible metabolic (meaning out of our control) reasons people who lose weight regain it: in a nutshell, being overweight programs our cells, via yet-to-be determined hormones and neurochemicals, to “defend” a certain weight, and if we manage to lose weight, our hormones and neurochemicals do everything possible to get the body to regain that lost weight. The article threw in additional theories about rapid weight loss being metabolically even more physiologically unsustainable. Uh huh. I know. I’ve known this for almost 40 years. One of my grad school professors, a world renowned nutrition scientist and one time director of the Food part of the Food and Drug Administration as well as a gourmet cook and connoisseur of fine wine, was one of the first to go on one of those very low calorie liquid diets. He did it under the supervision of the guys who were developing the diet. And he lost a boatload of weight, probably 150 pounds. And then he proceeded to regain 150 pounds, maybe more.

It doesn’t take a rocket scientist to understand why people regain weight. I recall him telling me he could hardly eat more than a plate of lettuce without gaining weight. Which confirmed what the Biggest Losers reported. Except his wife confided in me that as soon as he “finished” with his weight loss, he went right back to cooking and eating the way he had before starting the diet, not just the same foods and wines, but the same quantities! Which reminds me of something I once heard from Zig Zigler, famous motivational speaker. Mr. Zigler talked about his battle with weight and mentioned that he had lost the same 100 pounds about 15 times. He said he didn’t lose it for good until he had a complete change of mind set. Another big reason people regain their weight is that they just don’t adjust to their new, much lower, calorie needs. Our calorie needs are roughly based on our body weight. Pound for pound, muscle actually burns more calories than fat. When we lose weight, we lose a combination of fat and muscle, but considerable research has gone into trying to maximize fat loss and minimize muscle loss to try to keep our metabolism higher. In fact those very low-calorie diets were sometimes called a “protein sparing modified fast,” because researchers hoped their high protein content would “spare” the loss of muscle. But invariably, people would lose some muscle, so at the end of the day, or the diet, if a person lost half his body weight, his new calorie needs might be less than half what they were before the diet. Think of how hard it is to stick to a reduced calorie diet for a week, and then imagine having to spend the rest of forever subsisting on less than half the calories you were used to eating! When you’ve subsisted on a totally liquid diet for a year and you’re now faced with a world of food choices and no lessons on weight management! So it doesn’t take a rocket scientist – or even a brain researcher – to see why people regain the weight they’ve lost! The same thing can happen to folks who have weight loss surgery.

Losing weight is the easy part. By the time I started working in a weight loss clinic, nutritionists had already figured out that they needed to start teaching people right from the beginning how to make food choices that would allow them, when they reached their goal weight, to maintain that weight. But the people in my clinic were consuming totally liquid diets, of 500 to 800 calories a day, so it’s understandable that the lessons might be going in one ear and out the other. And while we would repeatedly emphasize the need to continue attending the clinic after losing weight so they could have our guidance as they started to practice the new skills we were trying to teach, some people thought it would be simple to just do everything “right,” so they stopped attending. Or, something would happen to convince people that in the process of losing weight, they had developed a new found ability to burn calories and could now eat whatever they wanted without regaining an ounce. Or, quite simply, no longer having the 5 protein drinks a day to define their food choices, they now had to contend with the reality of donut shops at every corner, snack foods at every checkout stand, long commutes, families at home waiting to be fed, sedentary jobs, inaccessible gyms, exhaustion, and limited hours in the day.

Now suppose my patients had been staying at a remote spa, where they were served delicious low-calorie, nutritionally balanced meals; had no calorically dense kid snacks sitting around to tempt them; didn’t have to plan their families’ meal; and spent their days being coached through rough physical workouts. Coming back to reality and not regaining weight would be even more difficult! .

It’s forever! The real lesson here, I think, which, it seems, was entirely lost on the writer of the NY Times article, is that weight management is not an interlude. It’s not a 2-week or even a 2-month spa visit. It’s not 6 months on a liquid diet and then back to reality, back to your old life. It’s forever! Not to discredit the amazing work neuroscientists are doing to discover the neurological mechanisms that make mice (and maybe us) want to eat or stop eating. Nor to minimize the huge challenges our habits and our environment present, and the constant, day-to-day work it takes to make successful weight management possible if you’re really determined to do the work. So the minute you make that commitment to losing weight and taking control, your first task is to start figuring out what you can do to eat less and burn more calories, and confirm it’s something you can live with for the rest of your life.